走钢丝——关于地方政客在实施基于循证实践的国家社会护理政策中所扮演角色的观点
Walking the tightrope-perspectives on local politicians' role in implementing a national social care policy on evidence-based practice.
作者信息
Bäck A, Ståhl C, von Thiele Schwarz U, Richter A, Hasson H
机构信息
Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden ; Center for Epidemiology and Community Medicine, Stockholm County Council, 171 29 Stockholm, Sweden.
Department of Medical and Health Sciences, National Centre for Work and Rehabilitation, Linköping University, 581 83 Linköping, Sweden.
出版信息
Int J Ment Health Syst. 2016 Dec 19;10:75. doi: 10.1186/s13033-016-0107-1. eCollection 2016.
BACKGROUND
Despite national policy recommending evidence-based practice (EBP), its application in social care has been limited. While local politicians can affect the process, little is known about their knowledge, attitudes and roles regarding EBP. The aim here is twofold: to explore the role of local politicians in the implementation of EBP in social care from both their own and a management perspective; and to examine factors politicians perceive as affecting their decisions and actions concerning the implementation of EBP policy.
METHODS
Local politicians (N = 13) and managers (N = 22) in social care were interviewed. Qualitative thematic analysis with both inductive and deductive codes was used.
RESULTS
Politicians were rather uninformed regarding EBP and national policy. The factors limiting their actions were, beside the lack of awareness, lack of ability to question existing working methods, and a need for support in the steering of EBP. Thus, personal interest played a significant part in what role the politicians assumed. This resulted in some politicians taking a more active role in steering EBP while others were not involved. From the managers' perspective, a more active steering by politicians was desired. Setting budget and objectives, as well as active follow-up of work processes and outcomes, were identified as means to affect the implementation of EBP. However, the politicians seemed unaware of the facilitating effects of these actions.
CONCLUSIONS
Local politicians had a possibility to facilitate the implementation of EBP, but their role was unclear. Personal interest played a big part in determining what role was taken. The results imply that social care politicians might need support in the development of their steering of EBP. Moving the responsibility for EBP facilitation upwards in the political structure could be an important step in developing EBP in social care.
背景
尽管国家政策提倡循证实践（EBP），但其在社会护理中的应用仍然有限。虽然地方政治家能够影响这一过程，但对于他们关于循证实践的知识、态度和角色却知之甚少。本文的目的有两个：一是从地方政治家自身以及管理角度探讨他们在社会护理中循证实践实施过程中的作用；二是研究政治家认为影响其关于循证实践政策实施决策和行动的因素。
方法
对社会护理领域的地方政治家（N = 13）和管理人员（N = 22）进行了访谈。采用了带有归纳和演绎编码的定性主题分析方法。
结果
政治家对循证实践和国家政策了解甚少。除了缺乏认识外，限制他们行动的因素还包括缺乏质疑现有工作方法的能力，以及在循证实践指导方面需要支持。因此，个人利益在政治家所扮演的角色中起到了重要作用。这导致一些政治家在循证实践指导中发挥了更积极的作用，而另一些则未参与其中。从管理人员的角度来看，希望政治家能进行更积极的指导。设定预算和目标，以及积极跟踪工作流程和结果，被认为是影响循证实践实施的手段。然而，政治家似乎并未意识到这些行动的促进作用。
结论
地方政治家有可能促进循证实践的实施，但其作用尚不明确。个人利益在决定所扮演的角色方面起到了很大作用。结果表明，社会护理领域的政治家在发展循证实践指导方面可能需要支持。将循证实践促进责任向上转移到政治结构中可能是社会护理领域发展循证实践的重要一步。
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